Abstract
Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of infection. To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. Rapid systematic review conducted in the medical school of the Federal University of São Paulo (SP), Brazil. We searched CENTRAL, MEDLINE, EMBASE, LILACS, SCOPUS, Web of Science, L·OVE, ClinicalTrials.gov and WHO-ICTRP for studies evaluating patients diagnosed with COVID-19 who were undergoing pharmacological treatment for IMID. Two authors selected studies, extracted data and assessed risk of bias and certainty of evidence, following the Cochrane recommendations. We identified 1,498 references, from which one cohort study was included. This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). Patients with RD were three times more likely to require admission to intensive care units (ICUs), with invasive mechanical ventilation (IMV), than those without RD: OR 3.72; 95% CI 1.35 to 10.26 (for both outcomes; very low certainty of evidence). Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID.
Highlights
In response to the current coronavirus disease (COVID-19) outbreak, many physicians and researchers have been concerned about patients with immune-mediated inflammatory diseases (IMID).[1,2,3,4] Through immunosuppressive treatment regimens, these patients may be more prone to infections with poor evolution of outcomes.[5]
Favalli et al.[3] showed that the incidence of COVID-19 was quite similar between rheumatic disease patients and individuals in the general population in Lombardy, Italy (0.62% versus 0.66%, respectively), a previous study showed that the most prevalent comorbidity among patients under 40 years old who had been diagnosed with COVID-19 and admitted to intensive care units (ICUs) was IMID.[6]
The participants with rheumatic disease were under pharmacological treatment, including: hydroxychloroquine (9 patients), hydroxychloroquine monotherapy (5), tumor necrosis factor (TNF) inhibitor (7), interleukin 6 (IL-6) receptor inhibitor (1), belimumab (2), rituximab (3), interleukin 12/interleukin 23 (IL-12/IL-23) inhibitor (2), abatacept (1), tofacitinib (3), methotrexate (9), leflunomide (4), mycophenolate mofetil (3) and prednisone (5)
Summary
In response to the current coronavirus disease (COVID-19) outbreak, many physicians and researchers have been concerned about patients with immune-mediated inflammatory diseases (IMID).[1,2,3,4] Through immunosuppressive treatment regimens, these patients may be more prone to infections with poor evolution of outcomes.[5]. OBJECTIVE: To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. RESULTS: We identified 1,498 references, from which one cohort study was included This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). CONCLUSION: Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID
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